A systematic review of different leadership approaches and their impact on the nursing team in emergency

Abstract

Emergency departments face demand variation, time pressure, and clinical risk. Leadership shapes nurse well-being, team function, and patient safety. Evidence on emergency nursing leadership remains dispersed across settings. This review synthesised findings within emergency department nursing contexts. This review examined leadership approaches in emergency departments. It assessed effects on nurse well-being, patient care and safety, and team dynamics. It also mapped leadership concepts used across the included studies. A systematic review followed PRISMA guidance. Searches covered PubMed, Scopus, CINAHL, and Web of Science. Studies from 2015 to 2025 met eligibility criteria. Eight studies met the inclusion criteria after screening and full-text review. Designs included five quantitative, two qualitative, and one mixed-methods. Quality appraisal used Joanna Briggs Institute checklists. Thematic analysis followed Braun and Clarke. Four themes emerged across the included studies. Theme one described leadership forms in emergency departments. Clinical leadership appeared as practice-based guidance and coordination. Authentic leadership appeared through transparency, ethics, and balanced processing. Transformational leadership was evident through motivation, support, and a focus on development. Toxic leadership appeared through authoritarian conduct and harmful team effects. Theme two linked leadership with nurse well-being outcomes. Supportive leadership is linked with lower burnout and higher satisfaction. Toxic leadership is linked with stress, burnout, and lower morale. Theme three linked leadership with patient care and safety. Supportive leadership enabled communication, staffing support, and safer care. Toxic leadership is linked to silence, reduced reporting, and increased safety risks. Theme four linked leadership with team dynamics outcomes. Supportive leadership is linked with trust, cohesion, and collaboration. Toxic leadership is linked with conflict, low commitment, and turnover intent. Leadership approaches shape emergency nursing work and care outcomes. Supportive leadership supports nurse well-being, teamwork, and care safety. Toxic 8 leadership harms staff health, teamwork, and safety processes. Further studies should test emergency-specific leadership mechanisms and outcomes.